Ortho Tribune U.S. Edition

interview Ortho Tribune U.S. Edition | PCSO PREVIEW 20156 II or Class III can be easily converted into light Invisalign treatment of less than 14 aligners. This also makes treatments less expensive for the patient and can boost the reputation of the clinicians because they are treating complex cases with simple procedures. The combined use of Motion with our new Passive self-ligating bracket Carri- ere SLX and Archwire sequence is really transforming complexity into simplicity while creating a dynamic and efficient scenario in our treatments. We feel satis- fied having been able to create the new Carrière SLX. Technically speaking, it has been a challenge. We needed to cre- ate a masterpiece of precision, so our en- gineers did their work, and we achieved the highest level of technical bracket out- comes. It’s a real game changer. How many cases have been treated with the appliance so far? In our office, right now around 100 cases already have been treated with Class III Motion. It can be astonishing to see the consistency of the extraordinary change to the face of the patient. Changes that you could imagine have been accom- plished surgically are not even being treated with a single extraction. I think the reason for this effect is the balanced combination of distalization of the low- er posterior segments, change of the posterior occlusal plane and counter- clockwise rotation of the mandible, completely changing the relation of the maxilla with the mandible. Distaliza- tion in the mandible is extremely fast and efficient, mainly because we have an almost “empty” highway in between the external cortical bone and the inter- nal cortical bone. That is the reason why we need very low force elastics in terms of traction. We only use 6¼ oz., and we normally never use 8 oz. in Class III as we would normally use in our Class II cases. In relation to the occlusal planes, in Class III we are going to see that we in- trude the lower molars with the Motion, and we extrude the canines. This extru- sion of canines and intrusion of molars is welcome in Class III and is necessary to change the occlusal plane. We bring the mandible back in a better functional and more esthetic position. The change in be- tween the maxilla and the mandible that happens in our Class II and Class III cases is the main reason why we changed the name of Distalizer to Motion. So the Carriere Motion appliance will change the relation in between the max- illa and the mandible in some part by changing the posterior occlusal planes, bringing the mandible and the maxilla into a better functional position while balancing the face in our Class II and Class III cases. In retrognatic Class II patients, we are going to combine upper distalization, controlled upper molar distal rotation and uprighting with mandibular reposi- tion in a better functional relation, giv- ing stability to the case, balancing the position of TMJ anatomical structures and harmonizing the soft-tissue facial esthetics. In Class III patients, we are promoting the posterior mandible repo- sition, changing the posterior occlusal planes and combining it with distaliza- tion of the posterior segments from canine to molars. Many times, this ap- proach will be combined with a certain “ CLASS III, Page 4 Figs. 4a, 4b: Patient before (a) and after (b) 14-month treatment. Fig. 4a Fig. 4b Figs. 5a-5c: Initial intra-oral shot (a), after one month of treatment with Class III Motion appliance, (b) shows the transpar- ent prototype, which is not yet available, and (c) final treatment outcome in 14-month follow-up. Fig. 5a Fig. 5b Fig. 5c Figs. 6a, 4b: Patient before (a) and after (b) three month of treatment with Class III Motion appliance. Fig. 6a Fig. 6b upper arch development with the Car- riere SLX passive system to compensate for the typical premaxillary hypoplasia related to this type of malocclusion. Our main objective is to establish a stable and solid occlusion while balancing the face of the patient. Were there also cases where the Class III occlusion could not been corrected? Did you notice any TMJ problems during the Class III treatment? In Class III, we normally find two types of Class III patients: dental and skeletal. The Motion Class III is an option for both. The skeletal discrepancies have been treated normally with a combina- tion of surgery together with orthodon- tics. But many patients reject the option of maxillofacial surgery. For many rea- sons, they reject the treatment, and they stay like they were. At this point, with this new approach, we can provide another minimally inva- sive treatment alternative to change that. This is a treatment modality in which we can provide to the patient great facial changes while keeping the facial icon and family traits. The Motion appliance in Class III is for dental and skeletal Class III cases. It is a plan B for those surgical cases. That is a great plan B that will be keeping the fam- ily traits while balancing the structures in a harmonious position on the icon of the face of the patient. We will not alter completely the struc- ture of the patient’s face, but we will bal- ance what features the patient has in a nicer position. And we will realign the patient’s features in a more harmonious way, so he can interact with others in his life with more self-confidence, compen- sated occlusion, facial improvement and spiritual equilibrium. No TMJ problems have been found at this point. Not a single patient has had any problem or symptomatology of TMJ with this approach. Class III many times has an additional functional shift of the mandible. So while balancing the oc- clusion, we balance the TMJ anatomical structural and functional relations and give peace to the area. Are there any studies that show the pro- portion of the mesialisation effect in the upper jaw and the proportion of the dis- talisation effect in the lower jaw of the to- tal correction of the Class III? This is a relatively new approach. We have no studies at this point, but related to the Carriere Class II Motion effect, Profes- sor James McNamara from the Univer- sity of Michigan and Professor Lorenzo Franchi from the University of Florence are studying our records and measur- ing them in order to give answers to this. They are tracing our cases to see what is going on, so we will have the results very soon. We can see clinically good and stable occlusion along many years. For example, you could now observe in my lecture several cases that have been out of retention for more than 10 years with a complete stability. But now we need ex- planations from the experts. What forces of elastics do you recommend for children and adults, and what is the recommended wearing time? Wearing time of elastics normally with the Motion appliance is 24 hours, except for eating, and with fresh elastics after each meal. In Class III in between the external cortical bone and the internal cortical bone in the sagital direction, from mesial to distal, we have a highway. There is no resistance, so we don’t need that much force. We only use 6 oz. In mixed dentition cases, in younger cases, such as a 7-year-old, in which we place a Class III Motion Appliance from the lower first molar to the lower tem- porary canine, what we are going to do is to slightly minimize the force. So we are going to go for 4 oz., or one quarter of an inch. That will be enough, and we can rise up to 6 oz. if we want, one half of an inch. With this technology, we will see huge changes on the face of the patient, beau- tiful balance of the face of the patient. This happens in our Class II and Class III patients in mixed dentition. Why? Because we change the the posterior oc- Fig. 7: Initial intra-oral shot. Fig. 7

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